Jorge Ocampo-Garza

Cutaneous coccidioidomycosis: a great mimicker.

An 18-year-old immunocompetent woman with a history of coccidioidal meningitis (positive cerebrospinal fluid complement fixation test, titre 1:128) who was treated 2 years earlier with placement of a ventriculoperitoneal valve because of hydrocephaly along with fluconazole (300 mg two times per day) for 5 months, was referred to dermatology because of a 3-year history of a dermatosis. Physical examination revealed two erythematous plaques with central atrophy and telangiectasias on the right cheek and dorsal aspect of the nose (figure 1). Skin biopsy demonstrated …

Angioimmunoblastic T-Cell Lymphoma: A Diagnostic Challenge

Angioimmunoblastic T-cell lymphoma (AITL) accounts for 15-20% of all peripheral T-cell lymphomas. It is a rare subtype of CD4 T-cell peripheral lymphoma that affects aged individuals, causing B symptoms, generalized lymphadenopathy and hepatosplenomegaly. Its pathogenesis is still unclear, but in some cases it has been associated with infection, allergic reaction or drug exposure. The majority of patients are diagnosed in an advanced stage and anthracycline based regimen is considered the first-line therapy. Skin involvement is not well characterized, occurring in up to 50% of patients and presenting as nonspecific rash, macules, papules, petechiae, purpura, nodules and urticaria. We present the illustrative case of a 55-year-old woman with an AITL who presented prominent skin findings, arthritis, lymphadenopathy and hypereosinophilia. Skin biopsy reported a T-cell lymphoma and the diagnosis of AITL was confirmed by an axillary lymph node biopsy, which was also positive for Epstein-Barr virus. Chemotherapy with CHOP-21 and thalidomide was given, accomplishing complete remission after six cycles.

Pigmented onychomatricoma: Four cases

Onychomatricoma (OM) presenting as a longitudinal melanonychia is a very uncommon clinical presentation with very few cases in the literature. Our aim in this article is to report four cases of pigmented OM, and describe their clinical and dermoscopic findings and the importance of the differential diagnoses, especially with melanoma.

Paraneoplastic pemphigus associated with primary pulmonar follicular dendritic cell sarcoma showing good response to treatment

References 1 Plasilova M, Chattopadhyay C, Pal P et al. Homozygous missense mutation in the lamin A/C gene causes autosomal recessive Hutchinson-Gilford progeria syndrome. J Med Genet 2004; 41: 609–614. 2 Reddy S, Comai L. Lamin A, farnesylation and aging. Exp Cell Res 2012; 318: 1–7. 3 Eriksson M, Brown WT, Gordon LB et al. Recurrent de novo point mutations in lamin A cause Hutchinson-Gilford progeria syndrome. Nature 2003; 423: 293–298. 4 Garg A, Subramanyam L, Agarwal AK et al. Atypical progeroid syndrome due to heterozygous missense LMNA mutations. J Clin Endocrinol Metab 2009; 94: 4971–4983. 5 Ding SL, Shen CY. Model of human aging: recent findings on Werner’s and Hutchinson-Gilford progeria syndromes. Clin Interv Aging 2008; 3: 431–444. 6 Lombardi F, Gullotta F, Columbaro M et al. Compound heterozygosity for mutations in LMNA in a patient with a myopathic and lipodystrophic mandibuloacral dysplasia type A phenotype. J Clin Endocrinol Metab 2007; 92: 4467–4471. 7 Hegele RA, Cao H, Anderson CM, Hramiak IM. Heterogeneity of nuclear lamin A mutations in Dunnigan-type familial partial lipodystrophy. J Clin Endocrinol Metab 2000; 85: 3431–3435. 8 Moller DV, Pham TT, Gustafsson F et al. The role of Lamin A/C mutations in Danish patients with idiopathic dilated cardiomyopathy. Eur J Heart Fail 2009; 11: 1031–1035.

Reacción por drogas con eosinofilia y síntomas sistémicos (síndrome de DRESS): Estudio retrospectivo de nueve casos

Background: DRESS Syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is an uncommon disease caused by drugs. It is characterized by a polymorphic disseminated eruption with fever and multiple organ dysfunction. Aim: To report the etiology, characteristics, treatment, prognosis, and follow up of patients with DRESS Syndrome admitted to a clinical hospital. Material and methods: Review of medical records of patients admitted for drug reactions, selecting those patients complying with clinical criteria for DRESS Syndrome. Drugs used during three months prior to the onset of symptoms were evaluated as possible causes of the disease. Results: Nine patients aged 16 to 68 years (six males) complied with the clinical criteria for the disease. The causative medications were carbamazepine in three patients, phenytoin in three, antituberculous drugs in two and amoxicillin in one. All were treated with systemic steroids with a complete clinical resolution. Conclusions: DRESS syndrome is usually underdiagnosed and has a good response to systemic steroids.BACKGROUND DRESS Syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is an uncommon disease caused by drugs. It is characterized by a polymorphic disseminated eruption with fever and multiple organ dysfunction. AIM To report the etiology, characteristics, treatment, prognosis, and follow up of patients with DRESS Syndrome admitted to a clinical hospital. MATERIAL AND METHODS Review of medical records of patients admitted for drug reactions, selecting those patients complying with clinical criteria for DRESS Syndrome. Drugs used during three months prior to the onset of symptoms were evaluated as possible causes of the disease. RESULTS Nine patients aged 16 to 68 years (six males) complied with the clinical criteria for the disease. The causative medications were carbamazepine in three patients, phenytoin in three, antituberculous drugs in two and amoxicillin in one. All were treated with systemic steroids with a complete clinical resolution. CONCLUSIONS DRESS syndrome is usually underdiagnosed and has a good response to systemic steroids.

Disseminated fusariosis with endophthalmitis after skin trauma in acute lymphoblastic leukaemia

PETT schedule, to successfully control both, metastatic growth in cutaneous and uveal melanoma by simultaneously targeting multiple hallmarks of melanoma: Communicative reprogramming may overcome (molecular-)genetic heterogeneity among melanomas of quite different origin as well as at different metastatic sites. PETT schedule provides a modest toxicity profile and omits maximal tolerable dosages of single drugs by concertedly modulating melanoma plus adjacent stroma cell functions. These promising data with PETT combination therapy are currently studied in a randomized phase II trial in second-line. A.R., C.H. designed the research, analysed the data and wrote the paper; C.H., M.V., Ch.H., M.L., M.B., S.H. and A.R. treated the patients; W.H. critically reviewed the manuscript.

Pseudo-pitting of the nail in psoriasis

Psoriasis is a chronic and recurrent inflammatory skin disease with a worldwide prevalence of approximately 1 to 3% causing significant distress and morbidity in the affected patients.1,2,3 Skin manifestations are the most characteristic findings of psoriasis, however, nail psoriasis is often overlooked despite its common occurrence.1,2 Nail involvement occurs in 61% of cases of cutaneous psoriasis and with a lifetime incidence among patients with psoriatic arthritis between 80% and 90%. About 1–5% of patients manifest with nail changes only.4,5 This article is protected by copyright. All rights reserved.

Cold subcutaneous abscesses as the first manifestation of disseminated coccidioidomycosis in an immunocompromised host.

Coccidioidomycosis is an endemic fungal infection in the southwestern USA and northern Mexico. It is caused by Coccidioides immitis and C. posadasii. This infection occurs due to the inhalation of airborne arthroconidia, causing a mild pulmonary infection, but most cases are asymptomatic. Disseminated coccidioidomycosis (DC) is a rare entity occurring in less than 1% of all cases, usually in immunocompromised patients, and it carries high risks of morbidity and mortality. The skin is one of the most frequently affected organs and in some cases cutaneous lesions may be the first or only sign of infection. A wide spectrum of clinical lesions may develop, including cold abscess. In immunocompromised hosts, DC represents a diagnostic and therapeutic challenge. Treatment is based on antifungal drugs, such as amphotericin B and azoles, administered for long periods of time and under close follow up to monitor the treatment response and to detect relapse. In the following case report, we present a 35‐year‐old male patient with systemic lupus erythematosus under immunosuppressive therapy who presented with cold subcutaneous abscesses as the first sign of DC.

Trichoscopy of Dark Scalp

Trichoscopy (dermoscopy of the hair and scalp) is a technique that improves diagnostic accuracy and follow-up with hair and scalp disorders. Although several studies of trichoscopy have been made in Caucasian and Asian populations, little has been published regarding trichoscopy findings in skin of color, despite the great prevalence of hair diseases in populations with this kind of skin. The aim of this review was to describe the trichoscopic features of normal scalp and of hair disorders in patients with dark skin phototypes. This will help dermatologists to distinguish between unique trichoscopic features of dark skin, and allow them to provide more accurate diagnoses and treatments for these patients.

Do Not Hurt the Nail Matrix: Safe Technique for Proximal Nail Fold Incision

Dear Editor, For a better view of the nail matrix during nail surgery, the proximal nail fold (PNF) must be incised and reclined. Two oblique incisions at 45° at the junction of the proximal and lateral nail fold are performed [1, 2]. As the nail matrix is just below the PNF, there is a considerable risk of hurting the matrix, and consequently nail dystrophy [1]. How to avoid this risk when both incisions are performed? The detachment of PNF from the nail plate is performed creating a space between them (Fig. 1a). The blade is placed horizontally into this space (Fig. 1b, c). By a rotation movement, the sharp blade portion is placed upward on the ventral portion of the PNF, while the dorsal part of the blade (not sharp) touches the nail plate and nail matrix (Fig. 2). Then, the incision is performed from the ventral to the dorsal part of the PNF, without any risk for the nail matrix. Received: January 12, 2018 Accepted: February 5, 2018 Published online: March 14, 2018